1.The Cost Of Dialysis In Malaysia: Haemodialysis And Continuous Ambulatory Peritoneal Dialysis
Naren Kumar Surendra ; Mohd Rizal Abdul Manaf ; Hooi Lai Seong ; Sunita Bavanandan ; Fariz Safhan Mohamad Nor ; Shahnaz Shah Firdaus Khan ; Ong Loke Meng ; Abdul Halim Abdul Gafor
Malaysian Journal of Public Health Medicine 2018;18(2):70-81
In Malaysia, dialysis-treated end stage renal disease (ESRD) patients have been increasing rapidly. Haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) use a disproportionately large amount of limited healthcare resources. This study aims to estimate the costs of HD and CAPD from the Ministry of Health (MOH) perspective. One year prospective multicentre study was conducted from October 2016 to September 2017 to assess direct medical costs of 90 HD patients and 73 CAPD patients from five large MOH dialysis centres. A mixed method of activity-based costing and step-down was used. The capital costs included land, building, medical equipment and furnishing. The recurrent costs included staff emoluments, facility utilities, patients’ medical costs and dialysis consumables. One-way sensitivity analysis was performed to investigate variability in the data. One hundred and forty-one patients (82%) completed the study comprising of 77 patients on HD and 64 patients on CAPD. Majority of the patients were between 46-65 years old (n=75, 53.2%). The most common aetiology of ESRD was diabetes mellitus (44.2% in HD and 48.4% in CAPD). Cost per patient per year was RM39,790 for HD and RM37,576 for CAPD. The main cost drivers were staff emoluments (37.6%) and dialysis consumables (70.5%) for HD and CAPD respectively. HD is highly sensitive towards all the variables analysed except for dialysis consumables. In CAPD, there are minimal sensitivities except for the 5% discount rate. Knowledge of the costs of modalities are useful in the context of planning for dialysis services and to optimise the number of kidney failure patients treated by dialysis within the MOH.
Haemodialysis
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continuous ambulatory peritoneal dialysis
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end stage renal disease
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cost
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Malaysia
2.A Meta-Analysis on the Performance of Cystatin C- versus Creatinine-based eGFR Equations in Predicting Vancomycin Clearance
Nor Asyikin MOHD TAHIR ; Shamin Mohd SAFFIAN ; Farida Hanim ISLAHUDIN ; Abdul Halim ABDUL GAFOR ; Mohd MAKMOR-BAKRY
Journal of Korean Medical Science 2020;35(37):e306-
Background:
The objective of this study was to compare the performance of cystatin C- and creatinine-based estimated glomerular filtration rate (eGFR) equations in predicting the clearance of vancomycin.
Methods:
MEDLINE and Embase databases were searched from inception up to September 2019 to identify all studies that compared the predictive performance of cystatin C- and/or creatinine-based eGFR in predicting the clearance of vancomycin. The prediction errors (PEs) (the value of eGFR equations minus vancomycin clearance) were quantified for each equation and were pooled using a random-effects model. The root mean squared errors were also quantified to provide a metric for imprecision.
Results:
This meta-analysis included evaluations of seven different cystatin C- and creatinine-based eGFR equations in total from 26 studies and 1,234 patients. The mean PE (MPE) for cystatin C-based eGFR was 4.378 mL min −1 (95% confidence interval [CI], −29.425, 38.181), while the creatinine-based eGFR provided an MPE of 27.617 mL min −1 (95% CI, 8.675, 46.560) in predicting clearance of vancomycin. This indicates the presence of unbiased results in vancomycin clearance prediction by the cystatin C-based eGFR equations.Meanwhile, creatinine-based eGFR equations demonstrated a statistically significant positive bias in vancomycin clearance prediction.
Conclusion
Cystatin C-based eGFR equations are better than creatinine-based eGFR equations in predicting the clearance of vancomycin. This suggests that utilising cystatin C-based eGFR equations could result in better accuracy and precision to predict vancomycin pharmacokinetic parameters.
3.Movement Disorders Resulting From Bilateral Basal Ganglia Lesions in End-Stage Kidney Disease: A Systematic Review
Kah Hui YAP ; Nurul Husna BAHARUDIN ; Abdul Halim Abdul GAFOR ; Rabani REMLI ; Shen-Yang LIM ; Wan Asyraf Wan ZAIDI ; Shahrul AZMIN ; Shahizon Azura Mohamed MUKARI ; Raihanah Abdul KHALID ; Norlinah Mohamed IBRAHIM
Journal of Movement Disorders 2022;15(3):258-263
Objective:
The basal ganglia (BG) are susceptible to fluctuations in blood urea levels, sometimes resulting in movement disorders. We described patients with end-stage kidney disease (ESKD) presenting with movement disorders associated with bilateral BG lesions on imaging.
Methods:
We report four patients and systematically reviewed all published cases of ESKD presenting with movement disorders and bilateral BG lesions (EBSCOhost and Ovid).
Results:
Of the 72 patients identified, 55 (76.4%) were on regular dialysis. Parkinsonism was the most common movement disorder (n = 39; 54.2%), followed by chorea (n = 24; 33.3%). Diabetes mellitus (n = 51; 70.8%) and hypertension (n = 16; 22.2%) were the most common risk factors. Forty-three (59.7%) were of Asian ethnicity. Complete clinical resolution was reported in 17 (30.9%) patients, while 38 (69.1%) had incomplete clinical resolution with relapse. Complete radiological resolution occurred in 14 (34.1%) patients.
Conclusion
Movement disorders associated with BG lesions should be recognized as a rare and potentially reversible metabolic movement disorder in patients with ESKD.
4.Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur
Boon Hau Ng ; Nik Nuratiqah Nik Abeed ; Andrea Ban Yu Lin ; Mohamed Faisal Abdul Hamid ; Lydia Kamaruzaman ; Muhammad Yusuf Abu Shamsi ; Halim Gafor ; Norlaila Mustafa, ; Wan Nur Nafisah Wan Yahya ; Shahrul Azmin ; Khoo Ching Soong ; Hemalatha Munusamy ; Zhen Hao Ching ; Hsueh Jing Low ; Petrick Periyasamy
The Medical Journal of Malaysia 2020;75(4):368-371
Background and objective: Coronavirus Disease 2019 (COVID19) was first reported in Malaysia in March 2020. We describe
here the clinical characteristics and computed tomography
(CT) patterns in asymptomatic young patients who had
laboratory-confirmed COVID-19.
Methods: This is a retrospective observational study where 25
male in-patients with laboratory-confirmed COVID-19 in
Hospital Canselor Tuanku Muhriz. Demographics, clinical
data and CT images of these patients were reviewed by 2 senior
radiologists.
Results: In total there were 25 patients (all males; mean age
[±SD], 21.64±2.40 years; range, 18-27 years). Patients with
abnormal chest CT showed a relatively low normal absolute
lymphocytes count (median: 2.2 x 109/L) and absolute
monocyte count (median: 0.5 x 109/L). Lactate dehydrogenase
was elevated in 5 (20%) of the patients. The procalcitonin level
was normal while elevated levels of alanine aminotransferase,
total bilirubin, platelet and C-reactive protein were common.
Baseline chest CT showed abnormalities in 6 patients. The
distribution of the lesions were; upper lobe 3 (12%) lower lobe
3 (12%) with peripheral distribution 4 (16%). Of the 25
patients included, 4 (16%) had ground glass opacification
(GGO), 1 (4%) had a small peripheral subpleural nodule, and
1 (4%) had a dense solitary granuloma. Four patients had
typical CT features of COVID-19.
Conclusion: We found that the CT imaging showed peripheral
GGO in our patients. They remained clinically stable with no
deterioration of their respiratory symptoms suggesting stability
in lung involvement. We postulate that rapid changes in CT
imaging may not be present in young, asymptomatic,
non-smoking COVID-19 patients. Thus the use of CT thorax
for early diagnosis may be reserved for patients in the older age
groups, and not in younger patients.